Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is health coverage offered by government-approved private insurance firms to provide all Medicare Part A and Part B benefits. Most MA plans also offer prescription drug coverage. Medicare beneficiaries must be enrolled in Medicare Part A and Part B to join the MA plan.

The program consists of several different health plans, which usually charge monthly premiums. However, some MA plans are available with zero premiums.

Medicare Advantage Eligibility

Those who qualified for and signed up for the Original Medicare plan are also, in most cases, eligible to enroll in a Medicare Advantage Plan. The primary exception to qualifying for an MA plan is for the beneficiaries who have End-Stage Renal Disease (ESRD). Patients with ESRD are always eligible for Medicare Part A and Part B, but can rarely enroll in Medicare Advantage plans.

Coverage Options

Unlike Original Medicare, where Medicare beneficiaries can go to any hospital, doctor, or other health-care providers that support Medicare, those who opt for Medicare Advantage have to follow the rules of the plan to get Medicare coverage. For example, some MA plans require beneficiaries to stay within the providers network.

Certain Medicare Advantage plans won’t cover those who go to a doctor’s office or clinics outside of the network. Other MA plans might cover beneficiaries who go outside the provider’s network, but they may need the beneficiary to pay more out-of-pocket for getting out-of-network care.

Medicare Advantage Cost

Medicare beneficiaries who enroll in an MA plan are required to pay their Medicare Part B premium. In addition to the Medicare Part B premium, beneficiaries may also pay an extra monthly premium.

The way Medicare Advantage costs are structured depends on the MA plan. Those who choose to get their coverage through an MA plan can get help paying for their coverage if they qualify for programs such as Medicare Savings Program or Medicaid.

Enrolling in Medicare Advantage

When enrolling in Medicare for the first time, beneficiaries are automatically enrolled in Original Medicare. When it comes to a Medicare Advantage plan, beneficiaries must specifically opt to receive their coverage through the plan.

There are limited times during the year in which beneficiaries can enroll in a Medicare Advantage plan. Those joining for the first time have an Initial Enrollment Period during which they can choose a plan. Beneficiaries can also switch, join, or disenroll from an MA plan during the Open Enrollment Period from October 15 to December 7. Special Enrollment Periods are also available for specific situations, such as when a beneficiary moves to a new location and loses their current coverage.

Get Help Today

Our agents at Senior Insurance Sales are Medicare experts that are ready to help you every step of the way. From learning more about Medicare Advantage to enrollment, we know how to make this process easy for you. Contact us today.

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